Hand & Wrist

Trigger Finger

The tendons of the thumb and each of the fingers pass through a sheath on the palm side of the hand. Certain diseases and overuse activities can cause a thickening of this sheath. As the tendon passes through a thickened sheath, the tendon eventually becomes irritated and swells. Pain, catching and eventually locking of the finger will occur. Early treatment consists of anti-inflammatory medication or Cortisone injection. If these fail to provide relief, the sheath is opened surgically through a small incision at the base of the finger.

Dupuytren’s Contracture

This is a disorder of thickened ligament in the palm, resulting in nodules on the ligament; which if severe enough can cause an inability to fully straighten the fingers. The ring and small fingers are most commonly affected.

The cause of this disorder is unknown. It is seen more commonly in men and is usually found in individuals of Northern European extraction.

If deformity is mild and there is no functional loss, no surgery is needed. If, however, there is significant contracture that interferes with full use of the hand, surgical removal of a portion of the ligament is the treatment of choice to improve function and to prevent further deformity.

De Quervain’s Tenosynovitis

Tendonitis on the thumb side of the wrist can be a very painful and disabling condition. Simple pinching and twisting activities can almost be impossible. The tendons to the thumb become inflamed as they pass under a ligament and the slightest motion of the wrist can cause pain.

Treatment consists of rest, medication and occasionally the use of a steroid injection. If these treatments do not provide relief over time, the tendons can be surgically released.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common hand problem resulting from pressure on the median nerve at the wrist. Symptoms, which often get worse at night, consist of numbness and/or pain in the wrist and fingers. Eventually there is loss of strength, fine motor control, and sensation.

Early treatment consists of splinting and anti-inflammatory medication. If symptoms do not improve, an outpatient surgical procedure to relieve the pressure on the nerve is suggested.

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Flexor and Extensor Tendon Injuries

Tendons are the bands of fibrous connective tissue that connect muscles to bone. Tendons aid in movement of the fingers, hand and all other body parts.

There are two types of tendons present in the hand- extensor tendons and flexor tendons. Extensor tendons present on top of the hand help with straightening the fingers. Whereas, flexor tendons that lie on the palm side of the hand help in bending the fingers. The flexor tendons are smooth, flexible, thick tissue strands which bend the fingers.

Nerve Compression Syndrome

Nerves transmit the impulses from brain and spinal cord to peripheral organs and entrapment or compression of the nerves, often at tunnel regions, may cause nerve compression syndrome. Nerves often susceptible for compression include the median nerve in the wrist, ulnar nerve at elbow, and radial nerve in proximal forearm. Compression of these nerved cause carpal tunnel syndrome, cubital tunnel syndrome, and radial tunnel syndrome, respectively.

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Microsurgery

The hand is considered one of the most complex structures in the human body due to its intricate anatomy. Your hands are a complex system of various bones, joints, ligaments, tendons, muscles, nerves and blood vessels. Without the healthy functioning of the hand we are unable to perform activities of daily living. The hand is one part of the body that is very susceptible to injury or disease. Some of these conditions include:

Fingertip Injuries/Amputations

Injuries to the fingertip can involve crushing, tearing, or amputation (cutting-off) of the tips of the fingers, which can occur at home, work or during play. Fingertip injuries can occur during every-day activities while using a knife, a lawnmower or snow blower, or when we jam our hands/fingers in the door. They are the most common injuries that occur to the hand. The tips of the longer fingers are more prone to such injuries. The skin, soft tissue, bone, nail and/or nail bed can become damaged with these types of injuries.

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Fingertip injuries in children

The surgeon will clean and prepare your child’s amputated fingertip and reattach it. Even in case of injury with bone exposure, the reattached fingertip should continue to grow normally. This is especially possible in children below 2 years of age.

Physical therapy

Exercise may be suggested for improving the strength and movement of your hands. Your doctor or physical therapist may suggest additional therapies such as electric stimulation of the nerves, heat and massage therapy, traction, splinting, and special wrappings to control swelling and promote healing.